Copyright © Italian Federation of Cardiology. Unauthorized reproduction of this article is prohibited. C-reactive protein and P-wave in hypertensive patients after conversion of atrial fibrillation Andrea Mazza a , Maria G. Bendini a , Marco Cristofori b , Massimo Leggio c , Stefano Nardi d , Andrea Giordano e , Raffaele De Cristofaro a and Giampiero Giordano a Aims P maximum/P dispersion and high-sensitivity C-reactive protein (hs-C-reactive protein) have been proposed as useful markers for predicting the history and recurrence of atrial fibrillation. We tested the association between hs-C-reactive protein and maximum P-wave duration (P maximum)/P-wave dispersion (P dispersion) in hypertensive patients after conversion of atrial fibrillation. Methods We enrolled 92 patients. Hs-C-reactive protein was assessed before cardioversion, the 12-lead ECG was recorded immediately after sinus rhythm restoration. Results At univariate analysis P maximum above 120 ms was associated with male sex (P U 0.0009), body mass index at least 25 kg/m 2 (P U 0.03) and hs-C-reactive protein greater than 0.30 mg/dl (P U 0.0001), and left atrium diameter greater than 40 mm nearly significant (P U 0.05). P dispersion above 40 ms was associated with hs-C-reactive protein greater than 0.30 mg/dl (P U 0.0001) and left atrium diameter greater than 0.40 mm (P U 0.03). P maximum/P dispersion (mean W SD) was significantly longer in patients with hs-C-reactive protein greater than 0.30 mg/dl compared to patients with hs-C-reactive protein 0.30 mg/dl or less (P U 0.0001 for both). At multivariate analysis P maximum above 120 ms was associated with male sex (P U 0.01) and with hs-C-reactive protein greater than 0.30 mg/dl (P U 0.002), whereas P dispersion above 40 ms was associated only with hs-C-reactive protein greater than 0.30 mg/dl (P U 0.0006). Conclusion Male sex and hs-C-reactive protein were associated with P maximum above 120 ms; hs-C-reactive protein was also associated with P dispersion above 40 ms in hypertensive patients after conversion of atrial fibrillation. Subclinical inflammation may be associated with delayed/ inhomogeneous atrial activation in hypertensive patients affected by atrial fibrillation. J Cardiovasc Med 2013, 14:520–527 Keywords: atrial fibrillation, cardioversion, hypertension, inflammation, P wave a Cardiology Division, Santa Maria della Stella Hospital, Orvieto, b Epidemiologic and Bio-Statistics Unit, AUSL Terni 4, Terni, c Cardiovascular Department, Cardiac Rehabilitation Operative Unit (S.I.), San Filippo Neri Hospital, Rome, d Cardiology Division, Santa Maria Hospital, Terni and e Nephrology Unit, Santa Maria della Stella Hospital, Orvieto, Italy Correspondence to Massimo Leggio, MD, Cardiovascular Department, Cardiac Rehabilitation Operative Unit (S.I.), San Filippo Neri Hospital, Via della Lucchina 41, 00135 Rome, Italy Tel: +39 06302511; fax: +39 0630811972; e-mail: mleggio@libero.it Received 17 September 2011 Revised 30 January 2012 Accepted 1 February 2012 Introduction Several studies have proposed maximum/mean P-wave duration (P maximum) and P-wave dispersion (P dis- persion) as useful markers for predicting both arrhythmic recurrences 1–4 and sinus rhythm maintenance 5 in patients affected by atrial fibrillation. P maximum and P dispersion have also been proposed for the identifi- cation of patients with a history of atrial fibrillation 6–9 and long-lasting atrial fibrillation. 10,11 Indeed, these parameters are expressions of atrial conduction delay and inhomogeneity, electrophysiologic substrates for atrial fibrillation onset and maintenance. On the contrary, there is consistent evidence of the association between high levels of high-sensitivity C-reactive protein (hs-C-reactive protein), a subclinical inflammation marker, and atrial fibrillation, 12,13 and hs-C- reactive protein has been reported as a strong predictor of atrial fibrillation recurrence after successful electrical cardioversion, 14,15 even if with significant heterogeneity between the studies. 16 The association between P-wave measurements and C-reactive protein has, however, been investigated only in studies evaluating patients affected by diseases with increased inflammatory activity. 17,18 The aim of our study was to test the association between a number of clinical/ instrumental variables, including hs-C-reactive protein, and P maximum/P dispersion in a cohort of atrial fibrilla- tion patients affected by a cardiovascular disease invol- ving an inflammatory mechanism, such as essential arterial hypertension. Original article 1558-2027 ß 2013 Italian Federation of Cardiology DOI:10.2459/JCM.0b013e32835224b5